Racism

Australia's first Indigenous ophthalmologist, Kristopher Rallah-Baker, says there is institutionalised racism within the health system.

Dr Rallah-Baker, who is the president of the Australian Indigenous Doctors' Association (AIDA), acknowledges the support he received at university, but found "blatant racism, degradation, training delays, bullying, harassment and racial vilification" in the workplace.

"Institutionalised racism, unconscious bias and cultural insensitivity might sound like buzzwords people kick around, but they are real and their impact is real."

He told RN that racism can be subtle, "or it can be obvious as it can be".

"The issue is that often difference is viewed with a little suspicious particularly in conservative systems like the medical and healthcare and hospital systems and so it can come in a variety of forms, but it was certainty there," he said.

Dr Rallah-Baker, who is based on Queensland's Sunshine Coast, believes the college training system structure leaves trainees disempowered and unable to defend themselves from superiors who have "absolute power" over their careers.

He says the system's flaws have been recognised by the organisations responsible for the recruitment and training of staff.

"I would hope that my own experience is one that is not actually repeated," he said.

"I think we are at a position that it probably going to be a fact. The organisations themselves across the board have opened to the reality of the system and are actively engaged in addressing those issues."

Cultural safety

Dr Rallah-Baker says cultural safety is about understanding differences between people no matter their background.

A lack of cultural safety is often a barrier for minority groups to access health services.

"If there is an institution that is perceived or is not engaging with people in an unjudging manner, then that in itself is a barrier for people to attend that institution," he said.

That can mean people don't seek treatment until a disease is very advanced — or don't seek help at all.

General practitioner Sarah Jane McEwan, a Wiradjuri woman who has spent the past nine years in Port Hedland in Western Australia's Pilbara region, says she is driven to deliver culturally safe and appropriate healthcare to her patients.

"I feel that having that influence in that space does improve the healthcare that we do deliver and certainty I am able to provide my lived experience in terms of how I approach things," she said.

"I think it is important to continue to focus on cultural safety in the workplace ... so that we have healthcare systems that are welcoming to our Indigenous patients and that they feel safe in and that they feel that they can [be] listened to and cared for appropriately."

Mental health

Clinical psychologist Tanja Hirvonen, who works in Darwin and is one of only about 120 Indigenous people working in the field, says prevention and intervention are "equally as important" as treating a person presenting with issues.

For example Port Hedland, which is home to about 16,000 people, doesn't have a psychiatrist.

"We rely heavily on referring our patients to tertiary centres such as Perth or to Broome, which is still six hours up the road from Port Hedland, to access the services they should be getting locally, ideally," Dr McEwan said.

"Those that aren't as acutely unwell to need transfer to these tertiary centres or specialised centres, they're parked under general physicians who perhaps may not have seen a mental health case since medical school and might be unfamiliar on how to actually care for the patient in the best way possible, all well-meaning of course."

She says there needs to be a focus on rural areas to ensure "our patients can actually have access to services that they deserve".

Advice for the young

Ms Hirvonen says it's "quite a long journey" to become qualified, "but when you get to the other side then you can hope to make a difference once you get through".

"If an Indigenous student is out there choosing an allied health career, any allied health career would be helpful," she said.

"I think you have got to go with your passion and I guess where you want to be making a difference."

She says her focus has always been on what more could be done in the mental health sphere, but she's seen some "amazing" occupational therapists and nurses, and notes there are now Indigenous podiatrists and physiotherapists.

"If we have greater numbers of Aboriginal and Torres Strait Islander people within all aspects of health we can continue to make a combined and collective impact and influence for our people."

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